In the treatment of both tuberculosis and the meningococcal carrier state, the small number of resistant cells present within large populations of susceptible cells can rapidly become the predominant type. Bacteriologic cultures should be obtained before the start of therapy to confirm the susceptibility of the organism to rifampin and they should be repeated throughout therapy to monitor the response to treatment. Since resistance can emerge rapidly, susceptibility tests should be performed in the event of persistent positive cultures during the course of treatment. If test results show resistance to rifampin and the patient is not responding to therapy, the drug regimen should be modified.

TUBERCULOSIS

Rifampin is indicated in the treatment of all forms of tuberculosis.

A three-drug regimen consisting of rifampin, isoniazid, and pyrazinamide (eg, RIFATERÂ®) is recommended in the initial phase of short-course therapy which is usually continued for 2 months. The Advisory Council for the Elimination of Tuberculosis, the American Thoracic Society, and Centers for Disease Control and Prevention recommend that either streptomycin or ethambutol be added as a fourth drug in a regimen containing isoniazid (INH), rifampin, and pyrazinamide for initial treatment of tuberculosis unless the likelihood of INH resistance is very low. The need for a fourth drug should be reassessed when the results of susceptibility testing are known. If community rates of INH resistance are currently less than 4%, an initial treatment regimen with less than four drugs may be considered.

Following the initial phase, treatment should be continued with rifampin and isoniazid (eg, RIFAMATEÂ®) for at least 4 months. Treatment should be continued for longer if the patient is still sputum or culture positive, if resistant organisms are present, or if the patient is HIV positive.

RIFADIN IV is indicated for the initial treatment and retreatment of tuberculosis when the drug cannot be taken by mouth.

MENINGOCOCCAL CARRIERS

Rifampin is indicated for the treatment of asymptomatic carriers of Neisseria meningitidis to eliminate meningococci from the nasopharynx. Rifampin is not indicated for the treatment of meningococcal infection because of the possibility of the rapid emergence of resistant organisms. (See WARNINGS.)

Rifampin should not be used indiscriminately, and therefore, diagnostic laboratory procedures, including serotyping and susceptibility testing, should be performed for establishment of the carrier state and the correct treatment. So that the usefulness of rifampin in the treatment of asymptomatic meningococcal carriers is preserved, the drug should be used only when the risk of meningococcal disease is high.

To reduce the development of drug-resistant bacteria and maintain the effectiveness of rifampin and other antibacterial drugs, rifampin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

Higher-dose rifampin for the treatment of pulmonary tuberculosis: a systematic review. [2011.03]OBJECTIVE: To provide a descriptive synthesis of the evidence assessing the efficacy and safety of higher doses of rifampin (RMP) for the treatment of pulmonary tuberculosis (TB)... CONCLUSION: Historical trials suggest that higher than standard RMP dosing results in improved culture conversion rates. Phase 2 and 3 clinical trials evaluating higher doses of RMP and other rifamycins are needed to confirm efficacy and assure tolerability. Pharmacokinetic studies will be needed to inform the development of such trials.

[Evaluation years in leprosy patients treated with single dose alternative scheme ROM (rifampin, ofloxacin, minocycline), after seven to nine]. [2010.11]INTRODUCTION: In 1997, after obtaining a combined multi-state double-blind randomly controlled clinical trial study from nine Indian centers involved in the treatment of Hansen's Disease, the Ministry of Health adapted the single dose ROM Therapy approach in those cases involving the treatment of a single skin lesion, paucibacillary leprosy without evidence of peripheral nerve trunk involvement and indication of negative baciloscope, in the Referral Centers in Brazil. The study aimed to evaluate the effectiveness of the single dose ROM Therapy approach in those patients who were treated from the period of 1997 to 1999 in the Ambulatory Dermatologic Unit in the Hospital in Vitoria, ES... CONCLUSIONS: The study demonstrated a rate of cure of 90.8% and a rate of relapse of 9.2% after a period of seven to nine years using the single dose ROM Therapy approach. Additionally, this alternative treatment further demonstrated a better effectiveness for a single skin lesion smaller than four centimeters and with an appearance in less than five years.

Effects of tuberculosis, race, and human gene SLCO1B1 polymorphisms on rifampin concentrations. [2010.10]Rifampin has concentration-dependent activity against Mycobacterium tuberculosis. However, marked intersubject variation of rifampin concentrations occurs... When adjusted for the patient mg/kg dosage and transporter gene polymorphisms, rifampin exposure was lower in patients with tuberculosis, which suggests that additional absorption or metabolic processes affect rifampin exposure with tuberculosis disease.

Pharmacokinetics of rifampin and clarithromycin in patients treated for Mycobacterium ulcerans infection. [2010.09]In a randomized controlled trial in Ghana, treatment of Mycobacterium ulcerans infection with streptomycin (SM)-rifampin (RIF) for 8 weeks was compared with treatment with SM-RIF for 4 weeks followed by treatment with RIF-clarithromycin (CLA) for 4 weeks... In further clinical studies, a dose of CLA of 7.5 mg/kg twice daily should be used (or with an extended-release formulation, 15 mg/kg should be used) to ensure higher levels of exposure to CLA and an increase in the time above the MIC compared to those achieved with the currently used dose of 7.5 mg/kg once daily.

Clinical Trials Related to Rifadin (Rifampin)

Safety, Tolerability, Extended Early Bactericidal Activity and PK of Higher Doses Rifampicin in Adults With Pulmonary TB [Active, not recruiting]
This is the first trial in a series of clinical trials that aim to bring the concept of high
dose rifampicin beyond phase II of clinical development.
The safety, tolerability, extended early bactericidal activity (EBA) and pharmacokinetics of
several doses of Rifampicin with or without standard doses of Isoniazid, Pyrazinamide and
Ethambutol in adults with newly diagnosed, uncomplicated, smear positive, pulmonary TB will
be assessed. The objective of this study is to find the maximum tolerable dose of Rifampicin
as monotherapy and in combination with the currently available Isoniazid, Pyrazinamide and
Ethambutol.
The subjects will be in the study for 24-31 days. After a screening period of 9-3 days, the
subjects will receive treatment with Rifampicin as single drug during 7 days (monotherapy).
This treatment will be followed by treatment with 7 days of Rifampicin and Isoniazid,
Pyrazinamide and Ethambutol (combination therapy), and 7-8 days treatment with standard TB
medication.
All subjects will be closely monitored for side effects. This monitoring will include daily
interviews and physical examination, and ECG evaluation and blood and urine analyses at
specific intervals.
During the 7 days of monotherapy, after the second day of the combination therapy and at the
end of the combination therapy, overnight sputum will be collected from the patients to
investigate the potency of high dose rifampicin to reduce this number of bacilli.
The Rifampicin dose will be increased step by step and group by group. The control group
will receive the standard dose of 10 mg Rifampicin/kg, whereas the first treatment group
will receive 20 mg/kg. The Rifampicin dose will only be further increased for a next group
of patients, if this is expected to be safe.
Rifampicin is widely available and not expensive. Physicians all over the world have
experience with this drug and its adverse effects. Should this study be successful, the
highest dose of Rifampicin that this safe and tolerable will be given to a larger group of
patients. in the next study.
If increasing the dose of Rifampicin proves to be safe and effective, a higher dose of
Rifampicin could be implemented broadly and quickly, and it would benefit many patients
worldwide.

Rifampicin Explorative PK Study for Tuberculous Meningitis Comparing Oral and Intravenous Preparation [Completed]
Tuberculous (TB) meningitis is the most severe manifestation of TB infection, leaving up to
50% of patients dead or neurologically disabled. Current treatment is similar to treatment
of lung TB, although penetration of some antibiotics into the brain is poor and the
immune-pathology of TB meningitis is very different from pulmonary TB. In a recent phase II
clinical trial from the investigators group, the first of its kind globally, intensified
antibiotic treatment, with moxifloxacin and high dose rifampicin, strongly reduced mortality
of TB meningitis.
The investigators aim to examine the effect of intensified antibiotic treatment on mortality
and morbidity of TB meningitis in a phase 3 clinical trial, preceded with an explorative
pharmacokinetic (PK) study to examine if higher oral doses rifampicin result in exposures
similar to the i. v. dose used in our phase 2 trial, since oral rifampicin could be
implemented much easier in low-resource settings.

High-dose Rifampicin for the Treatment of Tuberculous Meningitis: a Dose-finding Study [Recruiting]
Tuberculous meningitis (TBM) is the most severe form of tuberculosis infection with high
mortality. Current treatment regimens are not based on clinical trials. Rifampicin is a key
drug for TBM, but its penetration into the brain is limited, suggesting that a higher dose
may be more effective.
There are several highly relevant, outstanding questions related to the appropriate dose of
rifampicin for TBM, before a multicenter phase 3 trial can be performed. These are:
1. Previous phase 2a randomized clinical trial (done in the same setting as this proposed
study) suggests that high doses of intravenous rifampicin (600mg, circa 13 mg/mg) for
TBM is safe and associated with a survival benefit in adults. Given that i. v.
rifampicin is not readily available, this needs to be confirmed using an equivalent
higher oral dose of rifampicin.
2. Recent pharmacokinetic analysis of a continuation trial comparing 600 mg i. v.
rifampicin with 750 mg and 900 mg oral rifampicin suggests that an even higher dose may
be needed; but this has not been examined
3. Based on those previous data, there is a need to explore a longer duration of high-dose
rifampicin for a subsequent phase 3 randomized clinical trial; treatment response in
the investigators previous trial suggest that the optimal duration may be > 14 days.
4. There is a need to explore relevant treatment endpoints besides mortality including
neurological, neuroradiological and inflammatory response.

PATIENT REVIEWS / RATINGS / COMMENTS

Based on a total of 1 ratings/reviews, Rifadin has an overall score of 8. The effectiveness score is 8 and the side effect score is 10. The scores are on ten point scale: 10 - best, 1 - worst.

Rifadin review by 23 year old female patient

Rating

Overall rating:

Effectiveness:

Considerably Effective

Side effects:

No Side Effects

Treatment Info

Condition / reason:

MRSA abcess

Dosage & duration:

500 mg taken two times a day for the period of 10 days

Other conditions:

none

Other drugs taken:

none

Reported Results

Benefits:

The abcess and inflammation around the area disappeared. It is very important that MRSA abcesses be treated immediately. If you have a history of MRSA, get to your doctor and begin medication as quickly as possible. Rifmapin is a very effective drug for MRSA infections. The doctor will do a workup of all the effective medications against your specific MRSA infection and choose the appropriate antibiotic.

Side effects:

There were no side effects that I encountered. The drug must be taken on an empty stomach, which is not the case for many other antibiotics. If the drug is not taken on an empty stomach, its effects will be diluded and the drug will be less potent against the infection. It is always recommended to follow the instructions for any drug very closely, and as for rifampin, take it on an empty stomach.

Comments:

Rifampin is a drug used for MRSA infections. It is important that for any abcess that presents, for the doctor to take a culture of the bacteria and send it to the lab. Some abcesses are not MRSA infections, and others may be MRSA infections. MRSA can be very serious in elderly or immunocompromised patients, and will many times present as localized abcesses in the healthy patinet.